Anticoagulation

Question 1

What is hemostasis?

Answer 1

The process that stops bleeding after injury to a blood vessel

Question 2

What are the 2 stages of hemostasis?

Answer 2

1) Formation of a platelet plug

2) Reinforcement of the platelet plug with fibrin

Question 3

What is coagulation?

Answer 3

The process of blood clot formation

Question 4

What is a thrombus?

Answer 4

Intravascular blood clot

Question 5

What is an embolus?

Answer 5

A thrombus that travels from its site of origin

Question 6

What is the coagulation cascade?

Answer 6

The series of steps of coagulation that is like a domino effect because each activated clotting factor serves as a catalyst that initiates the next reatcion

Question 7

What is the end result of the coagulation cascade?

Answer 7

Large concentration of fibrin

Question 8

What is fibrin?

Answer 8

Clot forming substance

Question 9

What are anticoagulants?

Answer 9

Substances that prevent the formation of clotting factors, which prevents clot from forming

Question 10

What are antiplatelet drugs?

Answer 10

Substances that inhibit platelet aggregation (buildup)

Prevents platelet plug

Question 11

What are thrombolytic drugs?

Answer 11

Substances that lyse (break down) existing clots

Question 12

What are the drug subclasses of anticoagulants?

Answer 12

Heparin (Low Molecular Weight Heparin - LMWH)

Warfarin (Coumadin)

Question 13

What is the mechanism of action of heparin?

Answer 13

Binds to antithrombin III which turns off 3 main activating factors (II, IX, X).
Turns off coagulation pathway and prevents clots from forming

Question 14

What are the nursing implications for heparin?

Answer 14

Parenteral
Anticoagulation effects seen immediately
Short half-life (1-2 hours)
Monitored by activated partial thromboplastin times (aPTT)

Question 15

What is the antidote for heparin?

Answer 15

Protamine sulfate

Question 16

What are adverse effects of heparin?

Answer 16

Bleeding

Question 17

What is activated partial thromboplastin time (aPTT) used for?

Answer 17

aPTT measures how long it takes for a clot to form in a sample of blood

Question 18

What is a normal result of aPTT?

Answer 18

40 seconds

Question 19

What is a normal therapeutic result of aPTT?

Answer 19

1.5 - 2.0 times normal

Question 20

What is important to note about the administration of heparin?

Answer 20

It is a double-check medication

2 RNs must verify that this medication is administered correctly

Question 21

What is the mechanism of action of low molecular weight heparins?

Answer 21

Synthetic with smaller molecular structure than normal heparins
More specific for factor X
Has a more predictable anticoagulant response

Question 22

What are the nursing implications for low molecular weight heparins?

Answer 22

Does not require lab monitoring

Administered subcutaneously in abdomen

Question 23

What are some low molecular weight heparins?

Answer 23

Enoxaparin (Lovenox)

Dalteparin (Fragmin)

Question 24

What is the antidote for low molecular weight heparin?

Answer 24

Protamine sulfate

Question 25

What is protamine sulfate used for?

Answer 25

Antidote used in case of excessive anticoagulation

Question 26

What is the mechanism of action of warfarin?

Answer 26

Inhibits GI tract bacterial synthesis of vitamin K, which inhibits production of clotting factors II, VII, IX, and X Prevents clot formation

Question 27

What are the nursing implications for warfarin?

Answer 27

Administered orally | Monitored by prothrombin time (PT) and international normalized ratio (INR)

Question 28

What is the antidote for warfarin?

Answer 28

Vitamin K

Question 29

What is a warfarin drug?

Answer 29

Warfarin (Coumadin)

Question 30

What is prothrombin time (PT) used for?

Answer 30

Measures how long it takes a clot to form in a sample of blood

Question 31

What is a normal result of prothrombin time?

Answer 31

11 - 15 seconds

Question 32

What is international normalization rate (INR) used for?

Answer 32

Used as a standardized measure of coagulation achieved by drug therapy

Question 33

What is a normal result of INR?

Answer 33

1.0

Question 34

What is a therapeutic Coumadin INR level?

Answer 34

2.0 - 3.0

Question 35

What are the nursing implications for warfarin?

Answer 35

May be started while the patient is still on heparin until PT-INR levels indicate adequate anticoagulation Full therapeutic effect takes several days Monitor PT-INR regularly Vitamin K is the antidote

Question 36

What is the antidote for warfarin?

Answer 36

Vitamin K

Question 37

Between heparin and coumadin, which works faster?

Answer 37

Heparin works immediately, faster than coumadin

Question 38

What are some things to educate the patient about warfarin?

Answer 38

``` Take exactly as directed If dose is missed, take asap Do not double up on doses Review food high in vitamin K Must keep follow up appointments Use soft brush for brushing teeth Report any unusual bleeding/bruising ```

Question 39

Which foods are rich in vitamin K?

Answer 39

Dark green leafy vegetables

Question 40

What are adverse effects of anticoagulants?

Answer 40

``` Bleeding Nausea Vomiting Abdominal cramps Thrombocytopenia ```

Question 41

What are the contraindications of anticoagulants?

Answer 41

``` Severe uncontrolled hypertension Hemorrhagic stroke Bleeding disorders GI bleeding/ulcers Recent spinal cord surgery Opthalmologic surgery ```

Question 42

What are some things to educate the patient about anticoagulants?

Answer 42

Importance of regular lab testing Signs of abnormal bleeding Measures to prevent bruising, bleeding, or tissue injury Wearing a medical alert bracelet Consulting physician before taking other meds

Question 43

What are antiplatelet drugs?

Answer 43

``` Aspirin Clopidogrel (Plavix) ```

Question 44

What is the mechanism of action/drug effect of aspirin?

Answer 44

Results in dilation of blood vessels and prevention of platelets from aggregating or forming a clot Has analgesic, antiinflammatory, and antipyretic properties Has antiplatelet effects

Question 45

What are the indications for aspirin?

Answer 45

Stroke prevention

Question 46

What are the contraindications for aspirin?

Answer 46

``` Flu like symptoms in children and teenagers (Reye's syndrome) Allergy Thrombocytopenia Active bleeding Leukemia Traumatic injury Gastrointestinal ulcer Vitamin K deficiency Recent stroke ```

Question 47

What are the adverse effects of aspirin?

Answer 47

Drowsiness, dizziness, confusion, flushing Nausea, vomiting, gastrointestinal bleeding Thrombocytopenia, agranulocytosis, leukopenia, neutropenia, hemolytic anemia, bleeding

Question 48

What are the mechanism of action/drug effects of clopidogrel (plavix)?

Answer 48

Alters platelet membrane so that it can no longer receive the signal to aggregate and form a clot

Question 49

What are the indications of clopidogrel (plavix)?

Answer 49

Reduce risk for thrombotic stroke

Question 50

What are the contraindications of clopidogrel (plavix)?

Answer 50

``` Allergy Thrombocytopenia Active bleeding Leukemia Traumatic injury Gastrointestinal ulcer Vitamin K deficiency Recent stroke ```

Question 51

What are the adverse effects of clopidogrel (plavix)?

Answer 51

Chest pain, edema Flu like symptoms, headache, dizziness, fatigue Abdominal pain, diarrhea, nausea Epistaxis, rash, and pruritus

Question 52

What are the nursing implications of clopidogrel (plavix)?

Answer 52

Oral use only | Black box warning - genetic abnormalities may ave a higher rate of cardiovascular events

Question 53

What are the signs and symptoms of bleeding?

Answer 53

``` Bleeding gums Nose bleed Unusual bleeding Excessive bruising Black tarry stools Hematuria Fall in hematocrit Elevated PT ```

Question 54

What are the characteristics of urine output from anticoagulants?

Answer 54

Serosanguineous | Sanguineous

Question 55

What is serosanguineous?

Answer 55

Clear, watery, and tinged pink or pale red, denoting presence of blood

Question 56

What is sanguineous?

Answer 56

Bloody, **indicating active bleeding**